The most common question that I am asked as an attorney is how to prevent the nursing home from taking all of a parent’s money or some variation on that theme. The question stems from the astronomical cost of skilled or nursing home care. In Wayne County, the average nursing home cost is about $6,500 per month. We have very few clients whose monthly income in retirement could sustain that expense in addition to the monthly expenses of a spouse who remains at home.
In addition to a person’s own income and savings, there are other ways to help pay the cost of nursing home care if and when it would be needed. The first consideration should be long-term care insurance. There are many different types of long-term care policies, including joint policies and other benefits that can be tailored to a person’s anticipated needs. Insurance companies have many creative products that combine benefits to provide for other types of care that could allow a person to remain at home longer rather than be required to go into a nursing home. This includes policies that pay for in-home aides who provide housekeeping, meal preparation, transportation and other needed services that could make the difference between nursing home and assisted home care. Assisted living might also be an option in many policies and for those who qualify for a reduced level of assistance, this would be a more desired environment. The critical question to ask is to make sure that any long-term care policy qualifies for the Ohio Partnership Program which allows for an off-set of any policy amount purchased to be retained by the person who may later need to apply for Medicaid benefits when the long-term policy benefits have been exhausted. There is a window of opportunity when the purchase of a long-term care insurance policy makes sense and is not cost-prohibitive. We encourage our clients to meet with their trusted insurance agents to seek quotes and discuss policy options. The purchase of a long-term care policy can be a win-win to provide a greater flexibility of care options, including those that keep the person at home, while allowing asset protection in the event that Medicaid benefits are later needed.
Another underutilized option is benefits provided to military service veterans. In addition to medical care and treatment, the Veterans Administration can provide home health aides, medical equipment and other benefits to qualifying veterans, particularly those who served during a time of war or conflict even if they were not in actual combat. Additionally, the VA operates three facilities in Ohio, a nursing home in Georgetown in southern Ohio and a domiciliary and nursing home in Sandusky. These are available to veterans at a significantly reduced cost. We encourage any veteran to contact the Veterans Service Commission, located in every county in Ohio, to inquire about possible benefits. Social workers for the VA are also an invaluable resource and can help veterans navigate the benefits and options available. There are even some income assistance programs available to spouses of veterans.
Sometimes a person can stay at home with assistance. Meals on Wheels, home health aides and family members or paid caregivers can provide needed services that allow a person to remain in his or her home – always the preferred option. Family members who provide care can be compensated by the person for whom the care is provided. We recommend that the parties enter into a care contract and the person providing the care make sure to claim it as income for tax purposes. For certain families, this option can be the best way to allow a parent to stay at home while off-setting the loss of income to the family caregiver.
Finally, for those who are not candidates for the other options discussed above or have exhausted their resources, Medicaid will pay for assisted living or skilled nursing home care. There are stringent requirements to qualify for Medicaid, including income and asset limitations as well as monthly income limitations. Medicaid program qualification requirements are different in each state and the rules frequently change, so we urge our clients not to compare their situation or get advice from others who have applied for Medicaid in different states or in the past in Ohio. Each situation is unique and we strongly encourage those who anticipate nursing home level care in the future to contact an attorney early to review and discuss their specific situation and consider options that are available.
Cheryl M. Kirkbride